Human error in aviation and medicine has been linked to breakdowns in communication and teamwork, a professional culture that denies individual vulnerability to stress and fatigue, and organizational cultures that do not encourage the open discussion of error and are characterized by a "blame and punish" stance toward inevitable human error. The proposed research will use survey methodology that has been thoroughly tested and evaluated in the aviation domain to assess human factors variables at the individual level, as well as aggregate level professional and organizational cultures. Survey development will also be guided by the findings of the joint project of the center principal investigator (Thomas) and project leader (Helmreich) collecting human factors data in neonatal intensive care units (AHRQ grant # U1 8 HSI 1164). Survey data will be utilized to provide baseline measures of the cultural norms in targeted hospitals, with an initial focus on operating rooms, emergency rooms, and intensive care units. The survey data will also be used to develop experiential team training for all relevant health care providers. The efficacy of training interventions will be evaluated by participant evaluations, and pre-post changes in attitudes and behavior (assessed using videotaping of patient care). At the aggregate level, shifts in professional and organizational cultures will also be monitored. Research in aviation has demonstrated that, while training has a significant positive impact on safety-related attitudes and behaviors, the effects decay if training is not conducted on a recurring basis and appropriately reinforced by management action and policy. Accordingly, the project will monitor attitudes and organizational issues on an ongoing basis and use the data to update training and continue its focus on local issues. Once the survey and behavioral data collection processes have been thoroughly evaluated, a secondary goal of the project is to conduct a multiple center randomized trial, in which the impact of training on attitudes, behaviors, and patient outcomes is evaluated.